Transplant as a treatment for chronic lymphocytic patients who have progressed to Richter syndrome

This study aimed to investigate if allogeneic hematopoietic cell transplantation is effective in patients who have progressed from chronic lymphocytic leukemia to Richter syndrome.

This study concluded that allogeneic hematopoietic cell transplant is effective for these patients if they had an objective response before transplant.

Richter syndrome (RS) occurs when chronic lymphocytic leukemia (CLL) transforms into a lymphoma. Lymphoma is a cancer of white blood cells. RS occurs in 2 to 10% of patients with CLL. There is a poor outcome for CLL patients who progress to RS. Allogeneic hematopoietic cell transplantation (ACHT) is a therapy that may be used for RS. There is a lack of knowledge, however, about the effectiveness of AHCT in these patients.

This study involved 10 patients who had progressed from CLL to RS. Patients received ACHT at an average of 5 months from diagnosis of RS. All patients involved had an objective response to chemotherapy before ACHT. 70% of patients had received a myeloablative conditioning regimen. This is administered before transplant to encourage a successful transplant. Patients were followed for an average of 46 months. 

The 4-year overall survival rate was 50%. 49% of patients developed graft versus host disease (when transplanted cells attack healthy cells) after an average of 34 days. Non-relapse mortality (death not due to disease relapse) at 1 year after transplant was 40%. Non-relapse mortality at 4 years after transplant was 40% also. The 4-year incidence of relapse/progression was 10%.

This study concluded that AHCT is an effective treatment for RS patients who show an objective response before transplant.

The limitation to this study is that a small group of patients was used. Larger studies should be carried out.